Cardiovascular Business - September/October 2008 - (Page 19) Clinical Study Digest Researchers at Leeds General Infirmary in England examined 577 patients who underwent primary PCI between April 2005 and May 2007. They found that directly admitted patients had significantly reduced door-to-balloon (58 vs. 105 minutes) and call-to-balloon times (105 vs. 143 minutes). The 90-minute target for door-to-balloon time was achieved in 94 percent of direct admissions, compared to 29 percent of patients referred from the emergency room. “We believe this approach should be a key element of any contemporary primary PCI service,” they wrote. in one patient (left), endocardial trabeculae is well visualized with Rt3de. in a second patient (right), the spatial resolution of the technique is not sufficient and is likely to result in an incorrect LV volume. source: Victor Mor-avi, Phd, university of Chicago. AJC: Obese patients catch cath labs off guard Two-thirds of the busiest cath labs surveyed could not provide an answer when asked what they do when a patient’s weight exceeds the maximum allowable for the fluoro table. Researchers from William Beaumont Hospital in Royal Oak, Mich., surveyed 100 cath labs by phone. Ninety-four institutions submitted sufficient data (Am J Card 2008; 102[3]:285-286). The minimum, mean and maximum weight limits of the cath labs in this survey were 350, 437.5 and 550 pounds, respectively. Vanhecke et al reported that 22 percent of respondents referred patients to other institutions when their patients were too heavy, and 70 percent had no protocol in place. Researchers found that 5.2 patients per hospital per year were rejected for being over the weight limit, although only 62 percent of institutions answered this question. (GSM) measurements to determine the density of the carotid plaque. Plaques that appear dark on ultrasound images and have a low GSM level represent unstable plaques. Follow-up ultrasound exams on those with baseline plaque revealed that GSM levels had decreased in nearly half of the patients. Of those, 37 percent experienced a major adverse cardiovascular event within three years of the second ultrasound, according to the researchers. In contrast, 60 percent of patients experienced an increase in GSM levels and 28 percent experienced a major adverse cardiovascular event. The difference was significant. JACC: Real-time 3D echo correlates well with MR, with caveats In a clinical setting, real-time 3D echocardiography (RT3DE) analysis of left ventricular volumes correlates highly with cardiac MR. However, the tool is more reliable when users understand the drawbacks, according to a multi-center study (J Am Coll Cardiol Img 2008;1[4]:413-23). From a dataset of 92 patients with a wide range of ejection fractions, Mor-Avi et al from the University of Chicago found that RT3DE-derived LV volumes correlated highly with cardiac MR values, but were 26 and 29 percent lower consistently across institutions, with the magnitude of the bias being inversely related to the level of experience. The RT3DE measurements also were less reproducible than MR measurements. The major source of error, according to the study, was an inadequate spatial resolution of RT3DE imaging to always provide a clear definition of endocardial trabeculae (see image above), “which are, as a result, lumped together with the myocardium rather than being included in the LV cavity, as during analysis of CMR images.” Radiology: Serial ultrasound technique spots high-risk soft plaques in carotids Researchers have used a computer-assisted ultrasound program to identify soft plaque in the carotid arteries of high-risk asymptomatic patients, according to a study published in the September issue of Radiology. The technique was predictive of an adverse cardiac event. Markus Reiter, MD, and colleagues from Medical University Vienna in Austria used computer-assisted gray scale median CardiovascularBusiness.com Cardiovascular Business 19 http://CardiovascularBusiness.com
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